Cryptitis

Background

The interior of the anal cami and lower part of the rectum, showing the anal columns and the anal valves between their lower ends (columns in image numerous than typical).

Coronal section of rectum and the anal canal.

Anatomy of the anus and rectum.

• Cryptitis is associated with repetitive sphincter trauma from spasm, recurrent diarrhea, or passage of large/hard stools.

Pathophysiology

• Anal crypts are mucosal pockets that lie between the columns of Morgagni (i.e., anal columns)
  • Anal columns are a number of vertical folds, produced by an infolding of the mucous membrane and some of the muscular tissue in the upper half of the lumen of the anal canal.
  • Formed by the puckering action of the sphincter muscles
• Superficial trauma (diarrhea, trauma from hard stool) → breakdown in mucosal lining
  • Bacteria enter, inflammation extends into lymphoid tissue of the crypts / anal glands
    • Can lead to anal fissure, anal fistula, perirectal abscesses

Clinical Features

• Anal pain
• Sphincter spasm
• Itching with or without bleeding
• Hypertrophied papillae

Differential Diagnosis

Anorectal Disorders

• Anal fissure
• Anal fistula
• Anal malignancy
• Anal tags
• Anorectal abscess
• Coccydynia
• Colorectal malignancy
• Condyloma acuminata
• Constipation
• Crohn's disease
• Cryptitis
• GC/Chlamydia
• Fecal impaction
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• Levator ani syndrome
• Pedunculated polyp
• Pilonidal cyst
• Proctalgia fugax
• Proctitis
• Pruritus ani
  • Enterobius (pinworms)
• Rectal foreign body
• Rectal prolapse
• Syphilitic fissure

Non-GI Look-a-Likes

• Prostatitis

Evaluation

• Anoscopy shows inflammation, erythema, and pus

Management

1. Bulk laxatives, additional roughage, sitz baths (treats underlying cause)
2. Surgical referral is indicated when:
   • Infection has progressed and the crypt will not drain adequately on its own
   • Surgical treatment is excision

Disposition

• Outpatient

See Also

• Anorectal Disorders